Editorials

Critical gaps in laboratory leadership to meet global health security

goals
AdilyaAlbetkova,a JocelynIsadore,b JohnRidderhof,c ReneeNed-Sykes,c LucyMaryogo-Robinson,b EricBlank,b
SebastienCognat,d VirginieDolmazon,d PhilippeGasquet,d MarkRayfielda & LeonardPeruskia

Public health laboratories play a criti-
cal role in the detection, prevention
and control of diseases. However,
reliable laboratory testing continues
to be limited in many low- and middle-
income countries. 1 The 20132016
Ebola virus disease outbreak in West
Africa provided many examples of how
functioning laboratories were needed
for disease control and prevention ef-
forts. 2 This outbreak highlighted the
need for laboratory directors to be able
to influence national laboratory policy
and to implement national labora-
tory strategic plans. 3,4 Global health
initiatives such as The United States
Presidents Emergency Plan for AIDS
Relief (2003),5 the International Health
Regulations (IHR; 2005), 6 the Global
Health Security Agenda (GHSA; 2014)5
and the health-related United Nations
sustainable development goal (SDG3)
of the 2030 Agenda for sustainable devel-
opment (2015),7 all emphasize the need
for laboratory systems capable of provid-
ing affordable, sustainable and quality
laboratory testing. However, despite
progress made, only 22% (42/193) of
countries reported meeting the IHR core
capacities requirements for surveillance
and response by the June 2012 target
date and 34% (65/193) by the Novem-
ber 2015 target date.5,6 The GHSA was
launched in 2014 to accelerate progress
towards global health preparedness and
to support capacity-building efforts. The
GHSA objectives and IHRs core capaci-
ties overlap in several areas, including
laboratory systems and workforce de-
velopment.5
The GHSA Workforce Develop-
ment Action Package 8 outlines the
need for rigorous and sustainable
training programmes for public health
professionals and emphasizes the need
for practical, hands-on experience to
support public health systems. Ideally,
such programmes would help the public competency-based and laboratory-
health laboratory workforce in gaining specific leadership training as well as a
the skills and expertise to navigate an mentorship approach.
often-chaotic environment.9 In this context, WHO, CDC and
The World Health Organization the Association of Public Health Labo-
(WHO) has long articulated the need ratories have agreed to define leadership
for specialized training for laboratory competencies, based on CDCs and the
directors in the areas of leadership and Association of Public Health Labora-
management. Other initiatives have tories competency guidelines,14 and to
emerged, but they only partially ad- develop a Global Laboratory Leadership
dress the identified needs. The Centers Program to address gaps in the educa-
for Disease Control and Preventions tion and training of laboratory direc-
(CDCs) Laboratory Leadership Ser- tors. The Global Laboratory Leadership
vice10 is a new fellowship programme Program is a fellowship programme
that provides a comprehensive compe- that will use a standard curriculum and
tency-based leadership training in the implementation framework designed to
United States. The European Centre for transform mid-level laboratory manag-
Disease Prevention and Control also of- ers and scientists into effective leaders
fers the European Union Public Health for a critical component of global health
Microbiology Training Programme,11 a security.
fellowship which includes a leadership
and management training focused on References
Europe. The American Society for Mi- Available at: http://www.who.int/bulletin/vol-
crobiology (ASM)/CDC Program for umes/95/8/17-195883
Infectious Disease and Public Health is
a postdoctoral fellowship programme12
that strives to provide fellows with
in-depth and quality training on man-
agement in support of improving the
quality of health services; however,
the management and leadership con-
tent in the programme is limited. The
International Training and Education
Center for Health offers a certificate
programme in laboratory leadership and
management, but to date, it has been
implemented only in 10 countries in the
WHO Eastern Mediterranean region.13
These fellowship and training pro-
grammes offer varied approaches that
aim at reinforcing national laboratory
systems through workforce development
and have provided the first steps towards
strengthening competency attainment14
in public health laboratory leaders. All
initiatives point to the need for a com-
prehensive global framework, including

a
Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States of America (USA).
b
Association of Public Health Laboratories, Silver Spring, USA.
c
Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, USA.
d
World Health Organization Lyon Office, Lyon, France.
Correspondence to Adilya Albetkova (email: apa0@cdc.gov).

Bull World Health Organ 2017;95:547547A | doi: http://dx.doi.org/10.2471/BLT.17.195883 547

 Editorials
References
1. Olmsted SS, Moore M, Meili RC, Duber HC, Wasserman J, Sama P, et al.
Strengthening laboratory systems in resource-limited settings. Am J
Clin Pathol. 2010 Sep;134(3):37480. doi: http://dx.doi.org/10.1309/
AJCPDQOSB7QR5GLR PMID: 20716792
2. Goodfellow I, Reusken C, Koopmans M. Laboratory support during and after
the Ebola virus endgame: towards a sustained laboratory infrastructure.
Euro Surveill. 2015 03 26;20(12):21074. Available from: http://www.
eurosurveillance.org/images/dynamic/EE/V20N12/art21074.pdf [cited
2017July 7].
3. Nkengasong JN, Skaggs BA. Are post-Ebola reconstruction efforts
neglecting public health laboratory systems? Lancet Glob Health. 2015
Nov;3(11):e678. doi: http://dx.doi.org/10.1016/S2214-109X(15)00159-X
PMID: 26475013
4. Zwetyenga J, Oskam L, Slobodskaya O, Berdieva M, Turkmenova E,
Kasymbekova K, et al. Better labs for better health: Intersectoral challenges
and solutions for laboratory systems strengthening. Public Health
Panorama. 2015;1(2):1627.
5. Katz R, Sorrell EM, Kornblet SA, Fischer JE. Global health security agenda and
the international health regulations: moving forward. Biosecur Bioterror.
2014 Sep-Oct;12(5):2318. doi: http://dx.doi.org/10.1089/bsp.2014.0038
PMID: 25254911
6. Implementation of the International Health Regulations (2005). Report of
the review committee on the role of the international health regulations
(2005) in the Ebola outbreak and response. In: Sixty-ninth World Health
Assembly, Geneva, 13 May 2016. Report by the Director General. Geneva:
World Health Organization; 2016. Available from: A69/21 http://apps.who.
int/gb/ebwha/pdf_files/WHA69/A69_21-en.pdf?ua=1 [cited 2017 July 7].
7. Transforming our world: the 2030 Agenda for Sustainable Development.
New York: United Nations; 2015.
547A Bull World Health Organ 2017;95:547547A | doi: http://dx.doi.org/10.2471/BLT.17.195883
8. Global health security agenda. Action packages. Atlanta: Centers for
Disease Control and Prevention; 2014. Available from: http://www.cdc.
gov/globalhealth/healthprotection/ghs/pdf/ghsa-action-packages_24-
september-2014.pdf [cited 2017 July 7].
9. Smith T, Stankunas M, Czabanowska K, de Jong N, OConnor S, Fowler
Davis S. Principles of all-inclusive public health: developing a public health
leadership curriculum. Public Health. 2015 Feb;129(2):1824. doi: http://
dx.doi.org/10.1016/j.puhe.2014.12.001 PMID: 25707932
10. Laboratory leadership service (LLS). Atlanta: Centers for Disease Control and
Prevention; 2015. Available from: https://www.cdc.gov/lls/index.html [cited
2017 July 7].
11. European Union public health microbiology training programme. Technical
document. Stockholm: European Centre for Disease Prevention and Control;
2013. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/
publications/Publications/microbiology-public-health-training-programme.
pdf [cited 2017July 7].
12. ASM/CDC fellowship. Washington: American Academy of Microbiology.
Available from: https://www.asm.org/index.php/asm-cdc-fellowship [cited
2017 July 7].
13. Perrone LA, Confer D, Scott E, Livingston L, Bradburn C, McGee A, et al.
Implementation of a mentored professional development programme in
laboratory leadership and management in the Middle East and North Africa.
East Mediterr Health J. 2017 02 1;22(11):8329.
14. Ned-Sykes R, Johnson C, Ridderhof JC, Perlman E, Pollock A, DeBoy JM;
Centers for Disease Control and Prevention (CDC). Competency guidelines
for public health laboratory professionals: CDC and the association of public
health laboratories. MMWR Suppl. 2015 May 15;64(1):181. https://www.
cdc.gov/mmwr/preview/ind2015_su.html PMID: 25974716